Provider Demographics
NPI:1992523708
Name:LEFFLER-GUTIERREZ, EVELYN NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:NICOLE
Last Name:LEFFLER-GUTIERREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SYCAMORE CT APT 105
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5771
Mailing Address - Country:US
Mailing Address - Phone:407-374-4346
Mailing Address - Fax:
Practice Address - Street 1:2281 LEE RD STE 105
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7208
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-379897106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician